P-789 Unexplained subfertility in women aged 38 years and above: could intrauterine insemination be an alternative for in vitro fertilization? A systematic review and meta-analysis

Abstract Study question Considering current available evidence, how do intrauterine insemination and IVF compare in terms of pregnancy outcomes women aged > 38 years with unexplained subfertility? Summary answer In both IUI lead to pregnancies live births, there is insufficient evidence determine the relative effectiveness What known already Solid has shown that (IUI) ovarian stimulation (OS) preferred treatment option for subfertility below age 38. who are or older first choice treatment, according Dutch guideline order "not waste any more time” Evidence being effective compared IUI-OS lacking while an invasive, costly burdensome procedure. design, size, duration We have conducted a systematic review meta-analysis after comprehensive literature search which includes articles on IVF, IUI, both, from May 1985 2022. included randomized controlled trials cohort studies regarding and/or above mild factors. Participants/materials, setting, methods The primary outcome was birth rate safety miscarriage rate. Data comparative versus were pooled forest plot expressed risk ratio 95% CI using random effect model. calculated prevalence estimates performed meta-regression study Main results role chance 17 our meta-analysis. One RCT two cycles found halving (RR 0.46, 0.25-0.86. n = 154), very low-quality especially view unfair comparison time. Pooling data five IU resulted comparable estimate, though difference between not significantly different 0.56, 0.30-1.05, I2=73%, 7288), low quality unequal distribution female over groups heterogeneity. Meta-regression suggested 43 old chances 5% (3 397, only than 40). (8 studies, 22 708) following rates declined about 20% at year zero 44 years. At same time increased estimate 25% 50% Limitations, reasons caution Female age, likely modifier, equally distributed small studies. lacked information treatment. For fair horizon should be equal. Wider implications findings It expected average trying conceive will further increase within coming Findings this underline importance trial provide recommended subfertility. Trial registration number Not applicable